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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

Critical Care Nurses' Knowledge and Practice of Fever Management at a University Hospital

Labiba Abd kader Mohamed* and Nahla Shaaban Ali **

* Medical Surgical Nursing Dept, ** Critical Care Nursing Dept., Faculty of Nursing , Cairo University
lobnaqueen@yahoo.com

Abstract: Fever is a common problem in hospitalized patients in both the wards and the intensive care units. Much
of fever treatment is based on tradition and the belief that fever is harmful rather than scientific evidence. The aims
of this study were to identify the critical care nurses’ knowledge regarding fever management, assess their clinical
performance and explore the relation between nurses’ knowledge and clinical performance regarding fever
management of critically ill patients. A descriptive exploratory design was utilized. A sample of convenience of 70
critical care nurses was recruited from different critical care units at El Manial university hospital. Fever knowledge
assessment tool and performance observational checklist were utilized. The study results revealed that; the majority
of critical care nurses had unsatisfactory knowledge about physiology of thermoregulation (80%), pathophysiology
of fever (100%) and management of fever (70%). Observational checklists revealed that 100% of nurses assess fever
initially by measuring temperature only; while no plan of fever management was observed in nurses' documentation.
Nurses' implementation of fever management was confined to giving antipyretic medication and cold compresses
occasionally for febrile patients. Evaluation of the effect of nursing interventions and antipyretics weren't evident in
nurses' documentation. No correlation between the total knowledge score and average observations of clinical
performance was found (r= - 0.01, p =0.9) was found. The majority of participants' opinions regarding their current
fever management indicated that no specified protocol for fever management and less satisfaction with current
management. The study recommends that nurses' knowledge and clinical management of fever must be developed
through conducting in-service educational programs and developing a standardized protocol of care for fever
management in ICU.
[Labiba Abd kader Mohamed and Nahla Shaaban Ali. Critical Care Nurses' Knowledge and Practice of Fever
Management at a University Hospital. J Am Sci 2012;8(12):1545-1553]. (ISSN: 1545-1003).
http://www.jofamericanscience.org. 206

Keywords: Knowledge &practice, fever management, critical care nurses.

1. Introduction infectious and noninfectious fevers. The


Fever is a common complaint in hospitalized hyperthermia syndromes include environmental
patients and a common problem in both the intensive hyper-thermo (heatstroke) and drug-induced
care unit (ICU) and the patient ward, (Serrano , hyperthermia. Infectious fevers are caused by
2012) . The incidence of fever during a typical ICU bacterial, viral, fungal, and protozoal infections;
stay has been reported to vary between 5-70%.; more while noninfectious causes of fever are injury, heat
than 30% of ward patients and as much as 90% of stroke or dehydration (Hasan, et al., 2012 &,
critically ill patients experienced fever. It is estimated Serrano, 2012).
that nosocomial fevers occur in approximately one- Fever should lead to a careful physical
third of all medical patients at some time during their evaluation and clinical assessment of the patient
hospital stay in patients admitted to the ICU with rather than automatic orders for costly laboratory and
severe sepsis, (Ferguson , 2007; Peres, et al., 2004. radiologic studies that are commonly associated with
& Marik, 2000). Elevated temperature in patients a low diagnostic yield, (O’Grady,et al., 2008 &
has been linked to increased hospital and intensive Marik, 2000). Fever management requires
care unit lengths of stay, increased morbidity and knowledgeable assessment and treatment by critical
greater disability (Patricia & Laura 2012 &Peres, care nurses. Although temperature measurement and
et al., 2004) .In Egypt there was no available specific fever management are not often priorities in the
census for more updated incidence of fevers in ICUs. management of a critically ill patient, the physiologic
As there is variation in the incidence of consequences of fever may affect patient morbidity
reported fevers, the etiology of fever in critically ill (Henker & Carlson, 2007). Nurses are responsible
patients is similarly diverse. Both infectious and for diagnosing and treating fever, and using critical
noninfectious etiologies are common (Ryan & Levy, thinking allows nurses to provide safe and effective
2003). The major causes of abnormally elevated care (Patricia and Laura 2012). Therefore, it is
temperatures in the critically ill patient can be imperative for the critical care nurse to understand
broadly classified as the hyperthermia syndromes, the physiology of the fever cascade, have knowledge

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

scope and practice on how to cool a febrile patient It was found that none of the critical care nurses
and what methods of cooling should be used (Searle, addressed fever as a potential problem in nursing
2000). notes. Moreover, many patients had temperatures
Saxena, et al., (2012) mentioned that ranging from 37.5ºC to 39. 8º C), critical care nurses
through assessment and data collection the managed these patients' fever in different ways and at
formulation of a nursing diagnosis can be facilitated different levels of fever.
and increases the probability of successful planning, Inadequate measuring of body temperature
implementation and evaluation. Nurses must be able does not provide the evidence for what nurses do,
to give a reason for nursing actions. It is thus what they should do, or how do they apply
necessary for nurses to keep up with current; knowledge in their departments. Moreover, also,
acceptable standards of nursing, and be responsible inadequate documentation of nursing practice for
for the administration of prescribed medications. feverish patient forms a barrier to evidence-based
Samantha et al., (2010) mentioned that the critical practice. Accordingly, there will be insufficient
care nurses must bear knowledge of the evidence for changes in patient’s condition or
pharmacological content, dosages, effects, side- changes in nursing care. As the nurse plays a key role
effects and contra-indications of medication in relieving patient's fever, therefore hopefully this
administered by them to the patient. Finally, study results will generate attention and motivation
evaluating and documenting the patient’s response to for further investigation into this topic as well as the
nursing interventions and then comparing the lack of local researches concerned with such a
response to the outcomes criteria written in the problem necessitate the conduction of this study.
planning phase must be accomplished by the nurse.
When relevant information is recorded, all members Aim of the study
of the health team have a clear understanding of the The aims of this study were to:
patient’s progress. (Smeltzer & Bare,2010 and 1. Identify nurses’ current knowledge regarding fever
Sophia, 2003). management of critically ill patient.
Ferguson, (2007) mentioned that previous 2. Assess nurses’ clinical performance regarding
studies showed that nurses, clinicians and general fever management of critically ill patient.
populations have poor knowledge about fever and its 3. Explore the relation between nurses’ knowledge
management. Assessment and management of fever and practice regarding fever management of critically
were steeped in habits and teaching from the past. ill patient.
Research evidence suggested that if treating fever
was not based on accurate evidence then the use of Research questions
drugs would have little effect on the course of To fulfill the aim of this study, the research
disease. questions were formulated:
The management of a patient with fever 1- What is the current knowledge of critical care
continues to be controversial. Based on the reviewed nurses regarding fever management of critical ill
literature it is not clear to determine whether fever patient?
should be treated, and if treated, at what level 2. What are nurses’ clinical performances for adult
temperature and by what method. Hence it may be febrile patients in critical care units?
stated that there is a definite need for the conducting 3. What is the relationship between nurse's
of further research with regard to the fever knowledge and clinical performance regarding care
management in critically ill patients. The gaps in the given to adult febrile patients in critical care units?
literature related to fever assessment and
management are a challenging frontier for nursing 2. Subjects and Methods
research. (Holtzclaw, 2002). Research Design:
It was detected through empirical A descriptive exploratory design was
observations, and after studying patients’ flow utilized in the current study. Polit & Beck, (2006)
sheets, that critical care nurses working in the unit are mentioned that descriptive research provides an
inconsistent in respect of, and appear to be, uncertain accurate account of characteristics of a particular
about the management of fever. These management individual, event or group in real-life situations.
strategies also do not coincide with what the Exploratory research examines the relevant factors in
literature suggest. During the audit of nursing detail to arrive at description of the reality of the
documentation, several flow sheets were studied by existing situation.
the researchers; all concerned patients had the Setting:
potential to develop fever due to the This study was conducted in different
immune/inflammatory response system of the body. critical care units (Medical critical care, Coronary

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

care, Emergency critical care, surgical critical care, “ZERO". Based upon scoring system utilized, the
and Stroke critical care unit) at El-Manial University performance level was categorized as follows:
Hospital; affiliated with Cairo University in Egypt. satisfactory level is ≥ 60% and unsatisfactory level
Subjects: was < 60%.
Seventy nurses constituting all nurses Content validity:
working at different concerned critical care units who Face, content and concurrent validity for the
had a minimum of 1 year work experience and previously mentioned tools were revised and ensured
provide direct nursing care to their patients by five experts in medical surgical nursing and
constituted the sample of this study. Criteria for critical care nursing. Based on the experts' opinions
inclusion were age 20 or over, both sexes, and responses, the researchers developed the final
different educational categories. The exclusion validated form of the tools.
criteria were subjects who were piloted and refused Pilot study
voluntarily to participate in the study. A pilot study was done on 10 subjects to test
Tools: Two tools for data collections were utilized; clarity, applicability, understanding of language, and
they included: time needed for completing the tool. Few items were
Tool 1: - Interview questionnaire sheet: it was modified according to participants' responses in the
designed and used by the researchers and included pilot study. The subjects included in the pilot study
two parts: were excluded from the whole study sample.
Part 1: Socio demographic and educational Reliability assessment:
background data: it included data related to The developed and validated tool for the
subjects’ characteristics namely; age, sex, marital knowledge was tested for reliability on a sample of
status, years of experience, and educational level. 10 subjects. Test retest results using Alpha Cronbach
Part 2: Fever Management Knowledge revealed that all items are significantly differed and
Assessment tool: it included 30 questions related to has a correlation coefficient above the threshold of
Knowledge about physiology of thermoregulation (8 significance (r=0.8). On the other hand, the alpha
questions), pathophysiology of fever (9 questions), value for the performance checklist in the sample was
and nursing management of fever (13 (r=0.9).which indicating strong reliability of both
questions).These questions are derived from tools.
extensive literature review and previous related
studies. The structured questionnaire was in the form Procedure:
of multiple choice (20 questions) and true/false Once permission was granted to proceed
questions (10 questions). In addition, the with the current study from responsible and
questionnaire ended with an open ended question authoritative parties at El-Manial university hospital,
reflecting nurses' comments/opinions regarding their the researchers initiated data collection and contacted
nursing management of fever. The Scoring system each potential nurse to explain the purpose and nature
for the questionnaire had two alternative responses, of the study. The researchers emphasized that
the correct answer was given the score of “ONE” and participation in the study is entirely voluntary, the
the wrong answer was given the score of “ZERO. anonymity and the confidentiality of their responses
Based upon scoring system utilized, the knowledge were assured. Nurse participants were asked to sign a
level was categorized as follows: satisfactory level is consent form .The fever knowledge questionnaire
≥ 60% and unsatisfactory level was < 60%. sheet was administered, the total time allowed to
fulfill it by each nurse was 45 to 60 minutes. The
Tool 2: Nurses’ Clinical Performance time for collecting data through this tool from all
Observational Checklist: it was designed by the nurses consumed about 2 weeks. After that, an
researchers to assess nurse's clinical performance of observational checklist was utilized for each
fever management. This section consists of 22 items individual nurse three consecutive times, one week
related to observation of nurses' skills for fever apart. The researchers observed all the studied nurses
management practices utilizing the nursing process as individually throughout morning and afternoon shifts
a frame work for data collection and checking of using observational check list. The three times of
nurses' documentation of patients' care. It was observations of nurses' clinical performance and
distributed as follows; assessment (8 items), planning reviewing their documentation of patients' care took 6
(3 items), implementation (8 items), evaluation and months.
documentation (3 items). The Scoring system for the Ethical Consideration
developed observational checklist had two alternative Permission to conduct the proposed study was
responses, ' correctly done' skill was given the score obtained from the authorities of critical care units at
of “ONE” and 'not done' skill was given the score of El-Manial University Hospital affiliated to Cairo

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

University. The researchers introduced themselves to and changes in muscle tone . Also all the studied
nurses who met the inclusion criteria; the purpose sample reported that they do not assess subjective
and nature of the study was explained and then an data for their febrile patients. Only (28.5%) assessed
informed consent was taken from participants who possible causes of fever for their assigned patients;
accepted participation in the study. The researchers and (42.8%) monitored level of consciousness for
emphasized that participation in the study is entirely them. Related to planning of care for febrile patients;
voluntary; anonymity and confidentiality were the study findings showed that all participants
assured through coding the data. (100%) do not either formulate nursing diagnosis,
prioritize patient's concerns or put therapeutic goals
3. Results: before nursing actions. Related to implementation, all
The collected data were tabulated, analyzed participants (100%) didn't adjust or monitor
and presented in five main parts including: 1st part environmental factors like room temperature. In
subjects’ characteristic; 2nd part the subjects' addition, they do not administer an alternative
knowledge; 3rd part subjects' clinical performance; 4th antipyretic (e.g., Ibubrufen) if Paracetamol has been
part the relation between subjects' knowledge and ineffective in lowering the temperature; also all
clinical performance, and 5th part subjects' participants didn't report or record their actions
comments/opinions regarding knowledge and following facility policy. Regarding evaluation; all
management of fever. participants (100%) neither reassess hydration status,
Part I- Subjects’ Characteristics nor measure or record the urine output at time of
As can be seen from table (1), the majority fever.
of studied sample (77.15%) was females. Their age Table (4) presents one way analysis of variance for
ranged between 20 to more than 30 years with mean the comparison of mean clinical performance scores
age of 30 ± 6.7. , more than half (58.58%) were not of assessment, planning implementation and
married .In reference to the level of education; the evaluation for the three consecutive observations
subjects were mostly baccalaureate degree (68.57%). among the studied sample. As can be seen from the
Related to the years of experience, the majority of the table that no statistical significant differences existed
studied sample (75.72%) had more than 6 years of among the mean performance scores (F= 1.8, NS1.0;
experience, and the highest percentage of subjects F= 0.0, NS; F= 0.03, NS; F= 0.0, NS. respectively).
(45.72%) were working in medical critical care unit. Part IV: The relation between subjects'
Part II- Subjects’ knowledge about fever: knowledge and clinical performance:
Figure (1) presents distribution of knowledge score Table (5) presents the relationship between
about fever management among studied sample. It knowledge scores and performance for the three
shows that the majority of studied sample (82.86%) consecutive observations regarding fever
and (77.15%) had unsatisfactory knowledge about management among studied sample 1st observation (r
physiology and management of fever respectively; = -0.057, P=0.6); 2nd observation (r = 0.045, P =0.7);
while all participants (100%) had unsatisfactory 3rd observation (r = -0.01, p=0.2). It is apparent that
knowledge related to pathophysiology of fever. there is no significant statistical difference between
Table (2) presents comparison of the mean total knowledge scores and clinical performance
knowledge sub items scores of fever management scores among studied sample (r =-0.01, p=0.9).
among different educational levels of nurses. It is Part V: subjects' comments/opinions regarding
apparent from the table that there is no significant knowledge and management of fever:
statistical difference existed among them regarding As can be seen from the table (6) that all participants
physiology of fever, pathophysiology and (100%) start management of fever only if the
management of fever (F= 1.0, P=0.4; F=1.28, P=0.3; patients' temperature becomes 38.5 ºC. or more.
F= 0.6, P=0.6 respectively). Moreover, some of the participants (71.42%)
Part III- Subjects 'clinical performance about mentioned that they have unsatisfactory knowledge;
fever management: and the same percentage their opinion was that they
As can be seen from the table (3), that all know the management but have no time to manage
participants in the studied sample (100%) monitor fever. Finally, some participants (42.8%) reported
patient's temperature initially ; but didn't assess the that they are not satisfied with the current
presence of chills, diaphoresis and grade of fever management and only do what the doctor says or
(low / high); as well as the pattern of fever prescribe.
occurrence, assess mucous membrane for dryness

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

Table (1): Distribution of Socio-Demographic and educational background Data among studied sample (n=70).
Variables N %
Gender
- Male 16 22.85
- Female 54 77.15
Age
- 20 less than 25 20 28.57
- 25 less than30 31 44.28
- ≥30 19 27.15
mean± SD 30 ± 6.7
Marital status
- Married 29 41.42
- Not married 41 58.58
Level of education
- Secondary nursing school diploma 18 25.70
- Post secondary technical diploma 4 5.73
- Baccalaureate (BSc.N) 48 68.57
Years of experience
- 0-5 17 24.28
- 6 –10 years 42 60.00
- >10 years 11 15.72
Area of work
- Medical critical care 32 45.72
- Coronary care unit 16 22.85
- Emergency critical care 11 15.72
- Surgical critical are 7 10.00
- Stroke critical care unit 4 5.71

100.00%
80.00%
60.00%
40.00% physiology of fever
20.00% pathophysiology of fever
management of fever
0.00%
Satisfactory ≥unsatisfactory
60% <60%

Figure (1): Distribution of knowledge score about fever management among Studied sample (n=70).

Table 2: Comparison of means of knowledge scores about fever management by educational level among
studied sample (N=70).
Knowledge score about Educational level
fever Secondary nursing Post secondary Baccalaureate F. test P -value
school diploma technical diploma (BSc.N)
Mean SD Mean SD Mean SD
Physiology of fever 3.5 +0.6 3.5 + 1.0 3.77 +0.95 1.0 0.4 (NS)
Pathophysiology of fever 3.6 +0.7 4.2 +0.9 3.95 +0.71 1.28 0.3 (NS)
Management of fever 6.1 +1.2 6.7 + 1.7 6.41 +1.91 0.6 0.6 (NS)
(NS)= not significant

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Table (3): Frequency and percentage of nurses' clinical performance scores regarding fever management among studied
sample (n=70)
item Done correctly Not done
N (%) N (%)
1-Assessment
Objective data
1- Assess and monitor patient’s temperature 70 (100) 0 ( 0 %)
2- Note for presence of chills/ profuse diaphoresis & grade of fever (low/high) 0 (0 ) 70(100)
3- Note the pattern of occurrence ( sustained/remittent/intermittent) 0 (0 ) 70(100)
4- Assess mucous membranes for dryness & skin turgor 0 (0 ) 70(100)
5-Assess possible causes of fever 20 (28.5) 50(71.4)
6-Monitor for changes in level of consciousness, 30 (42.8) 40(57.1)
7-Assess changes in muscle tone 0 (0 ) 70(100)
Subjective data
8- Ask patient for comorbid symptoms, Feeling cold / restless /nausea /vomiting 0 (0) 70 (100)
/headache/ diarrhea/productive cough/dyspnea/dizziness/
2-planning
1-Identify priority of patient’s concerns. 0 (0 ) 70 (100)
2-Put therapeutic goal before an appropriate nursing action can be selected 0 (0 ) 70 (100)
3- develop individualized nursing care plan 15 (21.42) 55 (78.5)
3-implementation
1- Apply a thin blanket and avoid rapid removal of clothes 20 (28.5) 50 (71.4)
2-Adjust and monitor environmental factors like room temperature 0 (0) 70 (100)
3- Administer antipyretic medication in low grade fever at 37.50 -38.8 0 C & 20 (28.5) 50 (71.4)
Document rationale for antipyretic administration
4- Use and select a number of methods to cool down patients who have fever after 20 20 (28.5) 50 (71.4)
minutes of antipyretic medication ,
-or Apply tepid sponge bath in high grade fever (38.5 0 -390 C) 20 (28.5) 50 (71.4)
- or Administer an alternative antipyretic (eg., Nurofen) if Paracetamol has been 0 (0) 70 (100)
ineffective in lowering the temperature
-or Provide cooling blanket / ice packs especially with temperatures of 39.50C – 400C 25 (35.7) 45(64.28)
- or apply cold gastric lavage/ cold enema in patient with hyperthermia ( > 40 0 c) 2 (2.85) 68(97.14)
5-Measure temperature every 15 minutes 10 (14.28) 60 (85.7)
6- Increase fluid intake if not contraindicated 10 (14.28) 60 (85.7)
7-Apply a lubricant to dried lips and keeping mucous membranes moist 0 (0 %) 70 (100)
8- Report and record actions following facility policy. Include:
a. Site involved 0 (0 ) 70 (100)
b. Length of time treatment is given 0 (0) 70 (100)
c. Response to treatment 0 (0) 70 (100)
d. Observation of skin 0 (0 ) 70 (100)
4-Evaluation
1-Reassess temperature every 15 minutes and observe the antipyretics effect. 10 (14.28) 60 (85.7)
2-Reassess hydration status and skin turgor 0 (0 ) 70 (100)
3-Measure / record the urine output and Specific gravity at time of fever 0 (0 ) 70 (100)

Table (4): One way analysis of variance for the comparison of mean clinical performance scores for the three consecutive
observations among the studied sample (n=70).
Item of comparison Participants' performance
First observation Second observation Third observation F. value P value
Mean +SD Mean +SD Mean +SD
Assessment 2.35 0.7 2.31 0.5 2.27 0.5 1.8 0.1 (NS)
Planning 0.21 0.41 0.21 0.41 0.21 0.41 0.00 NS
Implementation 3.12 0.84 3.27 0.65 3 0.37 0.03 0.3 (NS)
Evaluation and documentation 0.1 0.3 0.1 0.3 0.1 0.3 0.00 NS
(NS)= not significant

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Table (5): Relationship between total fever knowledge scores and clinical performance scores among studied sample
(n=70).
variable Participants' performance
First observation Second observation Third observation Average of observations
r- test p- value r- test P- value r -test P- value r - test P- value
Total knowledge scores -0.057 0.64 0.045 0.7 -0.01 0.2 -0.01 0.9
(NS) (NS) (NS) (NS)
(NS)= not significant

Table (6): Participants' Opinions/comments regarding current knowledge and management of fever among studied
sample (n=70).
Participants' Opinions/Comments* N %
-Only manage if the patient becomes 38.50 C or more 70 100
-Only do what the doctor says or prescribe 30 42.8
-We are not satisfied with current management 30 42.8
-Our knowledge are insufficient 50 71.42
-We know the management but we have no time to apply 50 71.42
-No specified protocol for fever management 4 5.71
-We are satisfied with current management 4 5.71
-Fever management should proceed gradually 4 5.71
-Do not always approve of pharmacological management 5 7.14
-Reliance on policies and procedures rather than openness to change. 5 7.14
*more than one answer allowed

4. Discussion: management were clear in these critical care units.


The following discussion focus upon the findings These results were in agreement with Thompson
related to the stated research questions of the study. (2005), who thought that the concept of fever was
Discussion is presented in the following sequence: (a) unclear in nursing protocols for fever management.
nurses ' knowledge, (b) nurses' performance and(c) In the present study, the results obtained
Relationship between the nurses' knowledge and from the checklists regarding the utilization of the
practice. nursing process in fever management for critically ill
The current study results revealed that all critical patient revealed that; the assessment of the patient
care nurses with different educational levels, with fever or the potential to develop fever was not
irrespective of their years of experience or area of always recorded in the documentation. Accordingly,
work had unexpectedly unsatisfactory knowledge no nursing diagnosis was formulated. As evident by
scores about physiology of thermoregulation, observation of the performance of the studied
pathophysiology and management of fever. Similar subjects and patient documentations as well, the
findings were reported by Greensmith (2012), implementation of care showed inconsistency in
Considine, & Breman (2007), Edward et al., terms of frequency measuring and recording of the
(2007), Khalifa (2007), Walsh, etal., (2006), and patient temperature in the different shifts and for
Sophia (2003) who identified that nurses' mean different patients.
knowledge score about the physiology of fever, fever The implementation of care which carried
management and antipyretics was lower than out by the studied sample, the recommended frequent
expected. These results were also coinciding with and regular assessment of temperature was not done
Leaton (2010) who mentioned that most nurses and cooling patient after administering antipyretic
lacked knowledge about fever that associated with an medications, purposeful bathing patients in high
infective process that requires cultures to be obtained. grade fever and increasing fluid intake if not
Therefore, Sophia (2003) study findings contraindicated are measures not provided by all
recommended the inclusion of the physiology of participants. Thompson et al., (2007) and Stochetti
thermoregulation, the pathophysiology and the et al.,( 2002) reported that the care was confined to
management of fever in the curriculum of the erroneous fever management practices as the
undergraduate nursing students and all learning continued use of cold water compresses, or cold
programs for health care professionals. showers that could lead to shivering and more heat
The unsatisfactory nurses' knowledge in the production combined with administering oral
current study, may be due to the absence of in- paracetamol randomly irrespective of grade and onset
service training programs in fever management and of fever; these interventions have to be ineffective in
the absence of formal hospital policies for fever the majority of traumatic brain injury patients and

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

may actually be contraindicated as they could induce knowledge and educational level, and years of
shivering ,increasing metabolic rate and decreasing experience. These study findings may be interpreted
cerebral oxygenation . Therefore,(Holtzclaw, 2002) partially in the light of Thomboson (2007) study
reported that interventions chosen by nurses were which revealed that no improvement in clinical
frequently based on individual conventions rather practice over 10 years despite increased attention to
than evidence-based practice. Moreover, Leaton this issue and publication of guidelines. There
(2010) emphasized that most critical care nurses' remains a gap in translation between patient
managed fever by a variety of interventions not based outcomes research and bedside nursing practice that
on a protocol. needs to be overcome. As bedside nurses make
Finally, nurses' evaluation of the effect of nursing independent decisions in this regard, research efforts
care and antipyretics on the patient outcome was not need to focus on understanding their decision-making
done by all participants and not documented. These processes.
findings would be in accordance with Watts et al., Therefore, Lack of knowledge and practice
(2001), who mentioned in his study that the audit regarding fever management as noticed through
of nursing practices has highlighted a deficit in empirical observation and previous studies has
nurses’ documentation practices and a lack of clarity prompted the researchers to study the critical care
in the ordering of medications that have dual actions, nurses' opinions/comments regarding current fever
i.e., antipyretic and analgesic. The systematic review management practices in their work areas. The results
of fever management also recommended that the of the present study showed that most of nurse
purpose, when intervening in fever management, participants reported that they have insufficient
must be clearly identified through documentation knowledge, have no time due to workload, not
These findings may be interpreted in light of satisfied with the current management, reliance on
Ferguson, (2007) who found that assessment and policies and procedures rather than openness to
management of fever were steeped in habits and change and do what the doctor says.
teaching from the past. She added that research Results of present study in this regard
evidence suggested that if treating fever was not supported by the findings of Thompson and
based on accurate evidence then the use of drugs Kagan,(2011)who emphasized that institutional
would have little effect both on the course of disease protocols may provide barriers to implementation of
and the wellbeing of the patient. As well, Edwards evidence-based practice and need to be examined
et al., (2007) identified that neuroscience nurses who carefully. It is hoped that armed with this
encountered this common problem face a traditional knowledge, the evidence-based protocols can be
gap between patient-outcomes research and bedside developed and tested for fever management in
practice because there was no current evidence-based different patients that are both valuable to and fully-
standard of care for fever management. Thereby, implemented by critical care nurses.
pharmacological methods such as paracetamol may In conclusion, the findings suggest that
be administered erroneously. improvements are needed in the knowledge and
International studies conducted in US, Sweden management practices regarding fever among critical
and Australia reported a lack of consistency in the care nurses through a continuing education programs
way nurses described fever and its management based on scientific evidence.
(Edwards et al., 2007, Walsh et al. 2006, Recommendations:
Emmoth&Mansson ,1997). On the other hand, in Based on the results of the present study, the
Egypt, studies conducted by Mohamed (2010), Abd following recommendations are suggested:
El-Raheem (2007), Khalifa (2007), and Sliman - The need for in- service education and
(2005), revealed that nurses have adequate integration of clinical practice guidelines
knowledge but not adherent with evidence based regarding fever assessment and management.
guidelines in clinical practice. Therefore, there is a - Ward-based compulsory seminars or workshops
gap between what is already known and what is are considered an ideal educational tool to
really done. Improve fever management practices
There are other variables and factors that - Developing a standardized protocol of care for
may be closely related to the knowledge and practice febrile patients in ICU.
such as years of experience and educational level, i.e. - Examine the barriers of documentations.
the higher educational level and the more years of Finding a common language in nursing
experience, the better knowledge and the practice. documentation is essential. Therefore
However this study finding unexpectedly revealed Suggestions were made for improvement such
there is no correlation what so ever between as automatic documentation prompts in the
knowledge and clinical performance and between electronic medical record.

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Journal of American Science 2012;8(12) http://www.jofamericanscience.org

- Replication of this study to involve fever Critical Care Medicine and the Infectious Diseases
management among nurses caring for other Society of America. Crit Care Med; 36:1330–1349.
15. Patricia, A., and Laura, M. (2012).Fever Management in
vulnerable patients as cancer or burn patients is
Patients With Brain Injury, Advanced Critical Care,
necessary to determine June ,Vol. 23 No. 2, pp. 204 – 211.
16. Peres Bota, D., Lopes, Ferreira, F., Melot ,C., et
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